Government plans to revolutionise ambulance services, which could see an end to all 999 calls being sent directly to accident and emergency departments, are expected to be announced later this month.

Big rises in ambulance call-outs over the past decade have resulted in huge pressures on A&E staff - much of the rise being considered unnecessary because an estimated 50 per cent of cases turn out not to require emergency treatment.

The long-awaited Why Wait?

strategy document, covering the next three to five years in the service, is likely to result in paramedics being given greater powers to determine where care should be provided - including at a patient's home or within a primary care setting.

Other plans could also mean a further relaxation of the tight rules governing the range of drugs they can administer. It follows last year's announcement by the Department of Health giving specially trained paramedics the power to use six new drugs - including those for heart attacks and other life-threatening conditions - at the scene of emergencies.

And there should be greater emphasis on the use of IT. Pilot schemes have already been running in Staffordshire Ambulance Service trust - recently host to a pre-election visit by prime minister Tony Blair - so that medical data is sent directly to the control centre from ambulances.

The success of the IT initiative has led to the trust having talks with the business sector to help it equip crews with video links, allowing patients to be assessed at remote scenes by medical staff.

The Ambulance Service Association, which has just released its own report, The Future of Ambulance Services in the UK, said it believed the document would give the service greater flexibility in dealing with call-outs.

Chief executive Richard Diment told HSJ: 'It is about being able to deal with the range of calls that the ambulance service faces. And that does mean using more appropriate places to treat people. Specially trained paramedics can help ease the pressure currently endured by overstretched A&E departments.

'Everyone is aware of the tremendous demands being placed on the service. The public expect far more from the NHS than they did in previous years.

But it will require investment. I think we will get that as long as we can demonstrate to the DoH that we can modernise the service. '

HSJ understands that an ambulance service review commission could also be in the pipeline following the publication of the strategy document - again to look at the future of the service. Many of the issues, especially prioritisation, have been under discussion for a number of years but a few trusts have put new ideas into practice.

Cumbria Ambulance Service trust has been running a scheme whereby a nurse practitioner is assigned to crews, which has seen 18 per cent of patients being treated at home without the need to take them to A&E.

A spokesperson said: 'It has made a big difference to our work and we see no reason why it should not work elsewhere.

Because many of the communities here are so isolated, Cumbria has really benefited.

'It has lessened the impact on A&E and the patients are happier because they are not stuck in hospital facing long waits. '

The Future of Ambulance Services in the UK. ASA, Friars House, 157-168 Blackfriars Road, London SE1 8EU.£5.